NOTE: AS REQUIRED BY OHIO LAW, AN APPLICANT MUST POSSESS A HIGH SCHOOL DIPLOMA OR G.E.D., OTHERWISE WE CANNOT ACCEPT THE APPLICATION.

First Name*

Last Name*

eMail*

Phone Number

Address

City

State

Zip code

Social Security Number:

Application Date:

License Information (Number and State Issued):

Position Applying For:

Present Occupation

Did You Graduate?*

Educational Institutes Attended (Please list Name, City and State):

Have you ever been convicted of a felony:

Yes No

Employment References (Please list Name, Address, and Phone Number of two persons.):

Character References (Please list name, address, and phone number of two persons.):

Professional Licenses/Certifications

Can you work flexible hours:

Yes No

Did you submit a current resume:

Yes No

Voluntary Comments:

BY SUBMITTING THIS APPLICATION YOU AGREE TO THE FOLLOWING STATEMENTS:

*****APPLICANT'S EMPLOYMENT AUTHORIZATION AND RELEASE STATEMENTS*****

I understand that it is customary for employers to investigate and verify information contained within employment applications and other required employment-related forms. I further understand that any incorrect, incomplete or falsified information on this employment application and other required employment-related forms shall be cause for withdrawal of any offer of employment and termination of employment with COMMUNITY RESIDENTIAL SERVICES, INC.

I hereby authorize the appropriate authorities of COMMUNITY RESIDENTIAL SERVICES, INC., employer, to investigate and verify all information contained within this employment application and other, required, employment-related forms. Further, I hereby release such employer and authorized agents from any and all liability in the obtaining and appropriate use of such information. I realize that any sensitive information obtained shall be treated by COMMUNITY RESIDENTIAL SERVICES, INC. as confidential.
I also understand that i may be required to pass a comprehensive medical examination and/or drug screen tests done by appropriately licensed persons, a fingerprinting background check and to provide acceptable references as conditions of my employment.
If employment is offered by COMMUNITY RESIDENTIAL SERVICES, INC. and I accept such employment, I fully understand that such employment is strictly offered and accepted on the basis of "at-will" employment. "At-will" employment means that an employee may voluntarily resign his/her employment with or without cause at anytime for an nondiscriminatory reason. I understand that all employment-related documents provided to persons employed by COMMUNITY RESIDENTIAL SERVICES, INC. are to be considered and solely interpreted as part of the "at-will", non contractual employment.